When should you go to the hospital?

This information should serve as a general guideline of our doctors at Camelback Women’s Health approach to managing labor. Be certain to ask your doctor about any specific concerns or requests for your delivery.

When should I go to the hospital?

You should contact our office, day or night, when contractions are 3-5 minutes for one hour (or 15 strong contractions in a hour) or when your water breaks. The contractions should be sufficient intensity that you cannot walk through the contraction. For women that have had a baby before, or if you have had a cesarean section in the past, call us when the contractions are 5-6 minutes apart. It is very common to have contractions in the last month of the pregnancy that appear every 5 minutes apart in the evening time, but are very mild. This type of contraction tends to fade away by late evening.

If your water breaks, please let us know when it happens. If this is your first baby, you have plenty of time to go to the hospital and may be able to wait at home until contractions start. If you have had a child before, make arrangements for your child (children) immediately and begin heading to the hospital.

Be sure your baby is moving during the last month of the pregnancy.

Babies tend to roll more than kick after 36 weeks, but lack of movement for more than 4 hours is not normal. If you have any question about movement, lie on your left side and count for 10 movements after eating something cold. If this doesn't occur, contact our office. We do not want to hear that a baby has not moved in days, because our patients were afraid to call. Most often, simply listening to the baby on a fetal monitor for 20-30 minutes will reassure everyone that your baby is doing well.

For patients with long distances to drive, history of fast labor, or other special circumstances, please discuss these specifics with your doctor at your 36-week visit.

What can I do for the pain?

Modern obstetrics offers ever-improving options for control of labor pain. We have a common interest in helping you and your baby through labor as safely and as comfortably as possible.

Biofeedback is a very useful concept in approaching labor. Biofeedback works on the basis that your brain receives pain signals from other parts of the body equally from all other signals, but that these signals can be diverted if other signals are being processed first. Put simply: keep your mind doing other things, labor pain will be less noticeable.

Walking around, long showers, massage or even mental activities such as playing cards can help diverting your mind from contractions. Make plans to try these sorts of activities before you go to and when you get to the hospital. Try to keep walking as long as possible after getting to the hospital.

Please don't self-administer pain medicines at home before you come to the hospital. The doctors in our group believe in providing whatever options you choose to manage your labor pain, including natural labor without medication. If you would like medication or an epidural, please just ask. The timing of the medication is most important, in order to avoid complications or slow down your labor. We have no set dilation requirements for receiving an epidural or a cutoff when you cannot receive one.

Epidurals are extremely safe and do not cause long-term back problems. Risks of epidural are related to drops in blood pressure, which can be managed with fluids and medication, soreness around the epidural site for up to a week, and the risk of spinal headaches, which also can be managed with medication and added bed rest. These problems are very rare.

We encourage women to get an epidural if the labor is long or difficult. Frequently epidurals can even hasten delivery by allowing you to relax and get some needed rest.

Once you receive an epidural, you cannot get up or walk and frequently a catheter is placed in your bladder to prevent bladder distension. Your legs and lower stomach will lose sensation and will be difficult to move. Complete sensation returns 2-3 hours after an epidural is removed.

After delivery, oral medications will be offered. Ibuprofen or Tylenol are adequate for many patients, but other medications including Tylenol #3, Vicodin, or Percocet. Menstrual cramping usually last 3-5 days and episiotomy discomfort is significantly better within 2 days.

What are my chances for having a Cesarean Section?

The statistics both nationally and at our local hospitals is that the risk of a cesarean section in a first time mother is between 15-20%. This rate goes up to 20-25% if we include patients having repeat cesarean sections. The risk for cesarean in a patient who has had a previous normal delivery should be closer to 5-10%.

The three most common reasons for a first cesarean section are because the baby cannot get through the mother's birth canal, breech position (baby's buttocks is coming first), and because the baby shows signs of not tolerating the labor. There are numerous less common reasons for cesarean section. The most common reason overall for a cesarean section is a previous cesarean section.

Cesarean section is the most common surgical procedure in the United States and the risks associated with procedure are quite low. Nonetheless, there are risks with any type of surgery and the risks of cesarean are no different. These include bleeding, infection, damage to any internal organs and the risks of anesthesia. The risk of transfusion is below 3% any only would be done in cases where serious blood loss occurs. Most often, cesarean sections are done with epidural or spinal anesthesia so that you can be awake. Your spouse, significant other or family member can be in the room with you. Rarely, patients are put to sleep for cesarean sections.

After a cesarean section, most patients stay in the hospital 2-4 days. We allow clear liquids after your surgery and ask that you begin walking in the halls 12 hours after your surgery. The incision used is almost always a bikini type of incision that heals very quickly and is cosmetically quite concealed.

Scheduled repeat cesarean sections are generally done with spinal anesthesia, which allows for excellent pain relief for up to 24 hours, although other sensations and the ability to ambulate can return in 2-3 hours.

If I have had a cesarean section in the past, will I need another one?

The American College of Obstetrics and Gynecology has written very strict guidelines that require your obstetrician to be able to perform a repeat cesarean section quickly if you have had a cesarean section in the past. For this reason, any patient in our practice considering a VBAC (vaginal birth after cesarean section) will need to deliver at Good Samaritan, so that a cesarean section could be started by doctors that are in the hospital around the clock, until which time that we can get to hospital.

The risk of uterine rupture in patients with a previous cesarean section is quoted to be between 2-5%. Most often, signs of this occurring can be recognized before serious consequences can occur. Risks of VBAC can include injury or even death to either the mother or the baby.

If you are considering a VBAC, we will require that you sign an informed consent in the office at 36 weeks and at 36 weeks we will need to review the reasons for your cesarean. We would like to you an opinion based on your baby's size and cervical exam of the chances for a successful VBAC. Neither you nor your doctor want to have you go through labor and then have another cesarean.
 

Are episiotomies routinely done?

No. Each patient and each labor is different. The chance of a tear or any episiotomy depends on the number of children a patient has had in the past, the size of the baby and the mother and the length of the labor. Most of mothers that have had a baby before will not need an episiotomy. Small tears may still occur that need minimal suturing.

A great deal of controversy surrounds episiotomies in a first labor. It is not our policy to do routine episiotomies, however it will be quite evident to everyone in the labor room but the mother at the very last moments of pushing that a tear is imminent. In these circumstances, we all feel that a small clean episiotomy repairs easier, is less uncomfortable after delivery and heals quicker than a tear which frequently can distort anatomy and have a more compromised blood supply. We make every effort to avoid tears that extend towards the rectum.

Pain after a tear or episiotomy is usually well controlled with Ibuprofen or Tylenol #3. Topical anesthetic sprays are available and showers and baths can be used immediately after delivery. Ice is recommended for most mothers for the first 6 hours after delivery.

Do I need to contact my Pediatrician when I am in labor?

Most pediatric offices have an office orientation session for new parents once or twice a month in their office. If they don't, ask their office what their policy is on meeting a pediatrician before delivery.

If you are first time parents and do not have a pediatrician yet, ask one of our doctors for recommendations of a pediatrician near your home. Frequently, pediatric visits are needed on short notice for colds and flus and it is helpful to have a pediatrician near your home.

Another suggestion would be to ask neighbors with children or nurses in the pediatric wards of local hospitals, who a good pediatrician may be. A list of pediatricians that we are familiar with and the office locations is available on our web site. If you know of a good pediatrician that is not listed, let us know.

The hospital will take care of all contacts with your pediatrician. If your pediatrician does not come to the hospital that you are delivering at, let your doctor know after delivery and we will help you find a pediatric group that we are familiar with to take care of your baby while you are in the hospital. After you go home, these records can be forwarded on to your doctor.

Most babies are able to go home on day 1 or day 2 of delivery. The exception would be for babies of mothers who tested positive for Group B strep and did not receive two doses of antibiotics before delivery. An extra day in hospital is usually recommended and is only precautionary.
If you're having a boy and considering a circumcision, the pediatrician will usually do this on the day of discharge. Follow-up with your pediatrician when you go home is usually within 2-7 days.

One last thing:

The anticipation of labor can be very exciting, but sometimes frightening. Friends, neighbors and even strangers seem to relate their labor stories to pregnant women. What is certain is that your labor experience will be unique. There are risks to childbirth and we have chosen to work at hospitals that provide the very best in obstetric care.

Our goal as your doctor will be to guide you through the process as comfortably and safely as possible. Please ask questions both before your labor and at any time during the labor. Both our doctors and your labor nurse are there to take the mystery out of the labor experience. Tell us any special requests at your 36-week visit and let us know of any particular worries. If you know what to expect, labor can be much more tolerable and comfortable.

Try to get to bed early during the last month of your pregnancy, since labors tend to start at night and women that go into their labor tired tend to have more difficulty. Have your bags packed before labor and be sure your camera has film or batteries.

Lastly, this very unique time of your like and having this baby so close will soon be over forever. Despite the discomforts of these last weeks of the pregnancy, try to relish the last weeks of your pregnancy as much as is possible.

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